When Will Emergency Rooms Go Back to Being Emergency Rooms?

The University of Chicago hospital made headlines this week when it was criticized by the American College of Emergency Physicians for a plan that tries to get non-emergency patients out of its emergency room.

I’ve been fortunate to have only made one visit to the University of Chicago emergency room in the five years I’ve lived in Hyde Park. My youngest daughter Sophie was the reason for the visit. What had seemed like a run-of-the-mill kid’s illness had taken a turn for the worse. She had become extremely lethargic. She wouldn’t eat or drink and she had been vomiting, so we figured she was likely dehydrated. I took her to the University of Chicago emergency room at about 9 a.m. on a Sunday morning.

My visit started like most other visits to emergency rooms. When we arrived, there must have been 30 people in the waiting room. All of them were African-American. I filled out some paperwork and waited for the triage nurse to call my name to hear Sophie’s symptoms. At least half an hour passed and nothing had happened. I’m not usually very aggressive, but Sophie was looking worse and worse. So I went to the triage nurse and tried to do anything I could to see a doctor. I started by describing a set of symptoms that sounded like meningitis, even though she didn’t have all those symptoms. The nurse seemed unmoved. I then told her I had a son who died of meningitis. That definitely got her attention; but when she asked when he had died, and I said five years ago, she was much less impressed.

I guess she originally thought I meant he had died yesterday of meningitis. I told her that Sophie had become nonresponsive (and Sophie complied, staring off into space absently). I told her I was a professor at the university. I told her I would get my pediatrician on the phone. I’m not sure which of these strategies actually worked (I think it was being a professor), but within 10 minutes I was in to see a doctor. It turned out Sophie was badly dehydrated. They put an IV in her and she sprung to life. Our visit still took four to five hours. As we left, I was shocked to see that most of the people sitting in the waiting room when I arrived were still in the exact same spot, not yet having seen a doctor.

I don’t know the full history of emergency rooms, but I can’t imagine that the folks who designed them ever imagined they would turn out the way they have: a place where patients with no health care go to first wait six hours and then get routine care.

It is a system that makes no sense. If you read the description of what the University of Chicago hospital is trying to accomplish with its Urban Health Initiative that is being criticized, it does make sense.

Or you can do what my grandfather did and just avoid emergency rooms altogether. My grandfather was a doctor who practiced into his 80′s. I heard the following story from my father, so who knows what part of it is true, but this is how the story goes.

One day, while at home, my 80-something grandfather realized that he was likely having a stroke. He called in a prescription to the drugstore around the corner for some clot-busting drugs and sent my grandmother to the pharmacy to pick up the drugs. He crawled upstairs and got into bed. When my grandma got home, he took the drugs and just waited to see whether or not he would die. It turned out that he lived, with no noticeable side effects, which makes me wonder how true the story really is. One facet that I know is true, however, is that a man who spent 60 years of his life practicing medicine would do anything in his power to stay out of the hospital.

Leave A Comment

Comments are moderated and generally will be posted if they are on-topic and not abusive.

 

COMMENTS: 122

View All Comments »
  1. Nic says:

    Wow, I knew that one could do pretty cool things with instrumental variables but i didn’t know that they were used in emergency rooms as well!

    Thumb up 0 Thumb down 0
  2. JM says:

    As much as we would like to avoid emergency rooms, it has been a necessary evil two times in the past year (and we have excellent health coverage). The key is the triage nurses and process. Some hospitals are better than others obviously. We have walked into a ER with at least 50 people waiting and been seen within 30 minutes of our arrival….rightly so, as our situation turned out to be urgent but the key was triage. How quickly they evaluate and with a can-do attitude. Hats off to St Rose Hospitals in Southern Nevada!

    Thumb up 0 Thumb down 0
  3. Lewis says:

    Mike:

    http://www.mayoclinic.com/health/dehydration/DS00561

    “You can usually reverse mild to moderate dehydration by increasing your intake of fluids, but severe dehydration needs immediate medical treatment.”

    And given that the treatment is so simple, what exactly is wrong with dealing with it pronto?

    Basically, the problem with admitting teams is they don’t think you know what you’re talking about. If the professor thing is what did it, it’s because it convinced them that the person insisting so much may in fact be on to something regarding the severity of the condition.

    Thumb up 0 Thumb down 0
  4. Jenn says:

    Check for Urgent Care facilities or No Appointment Needed doctors if you have a non-life-threatening emergency.

    These typically move faster and I’ve always had great care from them.

    Thumb up 0 Thumb down 0
  5. Edwin Steussy says:

    After two episodes of arriving at an Emergency Room to find exactly the same situation (both cases were potentially life-threatening), we’ve hit on always calling 911 for an ambulance. With the ambulance service, you get qualified people looking at you immediately and they will handle the triage to get you to a doctor.

    Regarding the comment from Mike, I don’t think he has had the pleasure of having a loved one horribly ill and withering in front of you, while nurses routinely ignore your presence. You need to get their attention any way you can. I worked at a hospital for five years in the 80′s and have three doctors in my family – I know it does not have to be this way.

    Thumb up 0 Thumb down 0
  6. MS says:

    Of course, everyone in the ER thinks that their problem is an emergency — including you and your daughter. For many (40 percent according to the link you posted) it turns out not to be an emergency — also including you and your daughter.

    I don’t get it. You probably have enough money. Don’t you have a family doctor? Or a doctor you know who you could call? Or were you trying to save a few bucks?

    And I’m with #2, using your influences to help yourself and only yourself make you sound like a prima donna.

    Thumb up 0 Thumb down 0
  7. aaron says:

    @Mike

    He mentioned that she wouldn’t eat or drink, was vomiting, and that she was getting worse. I think he took the proper action going there as he had no way of knowing the actual root cause of the problem, if making her drink when she didn’t want too was dangerous or the routine illness was something more serious.

    Now he did override the judgment of the triage nurse by giving her false info which isn’t proper, but honestly given a parent with a sick child you’re going to have to expect that. It’s obvious from this article that the emergency room is being used by a lot of people who should go elsewhere. What isn’t obvious is if the triage performed its proper function. For instance if the triage nurse was initially correct in thinking his daughter could wait longer and if the other people were able to stand waiting longer for treatment.

    It seems that there’s two kinds of people who go to the emergency room, those with a medical emergency, and those who want quick and convenient treatment. If you can redirect the second group to alternate institutions than you’ve removed a lot of the problem.

    Thumb up 0 Thumb down 0
  8. JoseAngelCMS says:

    It’s stupid to call an Emergency Room one, when doctors are not ready to attend in case of an emergency. Doctors never appear and nurses are never ready to look at the people with any type of emergencies. The first thing they ask is for them to fill in a set of paperwork, when there are some patients who’s emergency doesn’t allow them to write.
    My sister is studying at Babson College and a friend of hers had to go to the hospital; she was not being able to breathe properly due to an asthma attack. My sister took her to the Emergency Room, and when they arrived they were told to fill out some paperwork, which my sister did for her, and even though the nurses saw how bad my sister’s friend was, they did nothing until my sister filled out all the paperwork. Fortunately, the help arrived before it was too late.
    The Emergency Rooms are called Emergency Rooms because they are supposed to treat any type of emergencies. There are some people, who in the case of an emergency just don’t have the time to fill out the paperwork or anything, and they shouldn’t be forced to fill them, losing so much time, therefore reducing their chances of survival.

    Thumb up 0 Thumb down 0